Evaluation de la totalisation dans le carcinome papillaire de la thyroïde

Abstract

Evaluation of totalization in papillary thyroid carcinoma.” Thyroid cancer has seen a significant increase in recent years, now ranking as the third most common cancer, after breast cancer and colorectal cancer. This rise primarily involves papillary thyroid carcinoma, both in Algeria and globally. The aim of this study is to analyze the epidemiological, clinicopathological, and therapeutic characteristics, with a particular focus on the type of surgical intervention to be proposed for patients residing in the Wilaya of Sétif. This descriptive epidemiological study examines a series of 87 cases of papillary thyroid carcinoma, with prospective data collection, conducted in the ENT department of Sétif University Hospital over a three-year period, from September 2021 to March 2024. Papillary carcinoma cases involved women in 85.05% of cases, and the average age of patients was 49.05 years, with no significant difference between sexes. Among the patients, 12.6% had a family history of papillary thyroid carcinoma, and 4 patients (4.6%) had a history of cured breast cancer. A suspicious nodule was incidentally discovered by thyroid ultrasound in 40% of cases, while 13% of diagnoses resulted from targeted screening, often due to the detection of papillary carcinoma in a close relative. Surgically, 68.9% of patients opted for total thyroidectomy after being informed about therapeutic options and the prognosis of this type of cancer. Partial surgery was performed in 27.6% of patients, 18.4% of whom required subsequent totalization due to the histological characteristics of the tumor. One-third of the tumors were microcarcinomas (pT1a), treated with partial surgery in 44.4% of cases, with 14.8% later requiring totalization. Two-thirds of the carcinomas were in patients under 55 years of age at stage I, while the remaining third involved patients over 55 years at stages I (31%) and II (2.3%). No prophylactic lymph node dissection was performed. Postoperative complications were observed in 7% of patients who underwent total thyroidectomy, compared to 1.2% in those treated with lobectomy. Complementary radioactive iodine therapy was necessary for 83.9% of patients, including 14.9% with microcarcinomas. No recurrence was observed in the thyroid bed, but secondary lymph node involvement occurred in 6.9 % of patients, requiring selective unilateral (4.6 %) or bilateral (2.3 %) cervical lymph node dissection. Thyroid cancer continues to progress in the Sétif region, though risk factors remain unclear. An in-depth epidemiological study of risk factors is crucial for developing better therapeutic strategies, marking an important step toward optimal management.